scholarly journals Surgical correction of coarctation of the aorta with distal aortic arch hypoplasia in infants

2016 ◽  
Vol 20 (2) ◽  
pp. 66 ◽  
Author(s):  
I. A. Soynov ◽  
Yu. S. Sinelnikov ◽  
I. A. Kornilov ◽  
N. R. Nichay ◽  
E. N. Gasanov ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Aortic Arch ◽  
Postoperative Period ◽  
Coarctation Of The Aorta ◽  
Surgical Correction ◽  
Group I ◽  
Group Ii ◽  
Aortic Arch Hypoplasia ◽  
Late Postoperative Period

<p><strong>Aim:</strong> The paper focuses on assessment of the late results and causes of complications when repairing coarctation with distal aortic arch hypoplasia.<br /><strong>Methods:</strong> This prospective randomized study included 54 patients who underwent repair of coarctation of the aorta. All patients were divided in 2 groups depending on the correction type: reconstruction using the modified reverse left subclavian artery flap plasty (Group I, 27 pts) or extended end-to-end anastomosis (Group II, 27 pts).<br /><strong>Results:</strong> A postoperative follow-up period was 26 (21;31) months. Recoarctation of the aorta during long-term follow-up was found in 1 patient (3.84%) in Group I and in 2 patients (7.7%) in Group II (p=0.5). Two patients in the Group I (7.7%) and 8 patients in the Group II (30.8%) had arterial hypertension (p=0.03).<br /><strong>Conclusion:</strong> With modern types of surgical correction used, the anastomotic area tended to proportionally grow in different segments of the aortic arch and did not influence the postoperative complications rate. Endocardial fibroelastosis and ascending aortic wall rigidity could be considered as predictors of arterial hypertension in the late period after coarctation repair in infants. Low body weight before surgery is a factor of aortic recoarctation development in the late postoperative period. Arterial hypertension persistence depends on the correction type. One-stage reconstruction of the distal aortic arch allows for reducing the rate of arterial hypertension from 30.8% to 7.7%. Despite a range of complications in the late postoperative period, the infants’ quality of life was not affected and was high in both groups.</p>

scholarly journals The influence of autonomic nervous system and elastic properties of the aortic wall on arterial hypertension progression in patients after surgical correction of coarctation of the aorta

2016 ◽  
Vol 20 (2) ◽  
pp. 74
Author(s):  
Yu. S. Sinelnikov ◽  
E. N. Gasanov ◽  
E. N. Orekhova
Keyword(s):  
Arterial Hypertension ◽  
Elastic Properties ◽  
Aortic Wall ◽  
Surgical Repair ◽  
Coarctation Of The Aorta ◽  
Surgical Correction ◽  
Control Group ◽  
Healthy Children ◽  
Group I ◽  
Group Ii

<p><strong>Aim:</strong> To assess sensitivity of the baroreceptors and elastic properties of the aortic wall in patients who underwent surgical correction of coarctation of the aorta.<br /><strong>Methods:</strong> In this prospective cohort study focus was placed on the evaluation of baroreceptors function and elastic properties of the aorta in 26 young patients who underwent surgical repair of coarctation of the aorta by using end-to-end extended anastomosis (Group I). The evaluation data obtained was then compared with that of the control group consisting of 26 healthy children without any congenital heart defects (Group II).<br /><strong>Results:</strong> Follow-up period was 25 (21;30) months. The spontaneous sensitivity of baroreceptors varied between the groups and was significantly higher in Group I 11.6 (10.5;12.6) versus 8.8 (8.1;9.9) in Group II, p=0.01. The velocity of pulsatile blood flow was higher in Group I 7.7 (5.8;9) (m/s) -1 versus 5.9 (4.8;7.1) (m/s) -1 in Group II, with a statistically significant difference between them (p = 0.003). The elastic properties of the aortic wall in Group I also considerably differed from those in the control group.<br /><strong>Conclusion:</strong> A high baroreceptors sensitivity and aortic wall stiffness in patients after surgical repair of coarctation of the aorta are direct predictors of arterial hypertension progression. However, it is important to assess the influence of the stroke volume on the rate of arterial hypertension incidence in patients who underwent surgical repair of coarctation of the aorta.</p>

The assessment of aortic coarctation among the children's population in lviv region

2020 ◽  
Vol 26 (4) ◽  
pp. 4-12
Author(s):  
A.А. Malska ◽  
◽  
O.B. Kuryliak ◽  
Keyword(s):  
Aortic Valve ◽  
Arterial Hypertension ◽  
Aortic Arch ◽  
Bicuspid Aortic Valve ◽  
Aortic Coarctation ◽  
Coarctation Of The Aorta ◽  
Oval Window ◽  
Surgical Correction ◽  
Congenital Defects ◽  
Surgical Methods

Aim. To determine the rate of aortic coarctation, the correlation of its anatomical forms - critical and not critical, and the frequency of combination with the associated pathology; to define the features of the clinical course of its different anatomical forms; and to analyze the remote results of the surgical correction of this defect. Material and Methods. The article represents the statistical analysis of outpatient medical records and case histories of 86 children with aortic coarctation in Lviv region. In the course of the research, retrospective and epidemiological studies were carried out; clinical (data acquisition of medical history, physical examination), instrumental (Doppler echocardiography, ECG, X-ray imaging of organs of the thoracic cavity), and statistical methods were used. Results and Discussion. It was determined that over the period of 2008-2020 years, out of 74 neonates with CoA registered at Lviv Regional Children's Hospital (Health Care of Mother and Child) 40,54% had the critical CoA form, while 59 (46%) - uncritical CoA form. In children with the critical CoA form, the most frequent findings were hypoplasia of the aortic arch (56,67%), open aortic duct (53,33%), and open oval window (53,33%); in 36,6% cases CoA was combined with the bicuspid aortic valve, interatrial septal defect, and transposition of great vessels. However, the uncritical CoA form was more frequently combined with the bicuspid aortic valve (52,27%), and hypoplastic aortic arch (31,82%); aortic stenosis was revealed in 20,45% of children. After the surgical correction in 43,59% of the operated patients with uncritical CoA, excessive arterial hypertension was observed, while in critical form, the frequency of excessive arterial hypertension among the operated patients amounted to 10%. According to our research, after the plasty of the critical CoA, aortic recoarctation was observed in 3.33% of the operated patients, whereas, in case of the uncritical CoA form, it occurred in 30,77% of the operated ones. Conclusions. Coarctation of the aorta is a congenital heart disease with relatively high incidence, amounting to 5-8% out of all congenital defects of the heart. In newborns, it is manifested by acute cardiac failure, while in elder children it is presented with arterial hypertension. Echocardiographic examination after Doppler analysis is the basic procedure of diagnostics and allows for precise determination of the CoA anatomy. The majority of cardiologists recommend prompt surgical intervention after the diagnosis has been made, and, particularly, in patients with hypertension. At present, the available surgical methods include surgical excision of the aortic obstruction, and catheter intervention (the balloon angioplasty and stent implantation) . After the surgical correction has been performed, arterial hypertension persists. The duration of hypertension after the coarctation correction depends on its duration before the diagnosis is made and the timing of surgical correction of the defect. With the child's growth , recoarctation may occur. In such patients, normal arterial pressure can be determined in the state of rest, but it may increase in the upper extremities during physical exertion. Key words: aortic coarctation, associated pathology, excessive arterial hypertension, recoarctation

scholarly journals Safety and efficacy of stenting for aortic arch hypoplasia in patients with coarctation of the aorta

2019 ◽  
Vol 28 (3) ◽  
pp. 145-152
Author(s):  
E. G. Warmerdam ◽  
G. J. Krings ◽  
T. A. Meijs ◽  
A. C. Franken ◽  
B. W. Driesen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Aortic Arch ◽  
Retrospective Analysis ◽  
Medical Center ◽  
Systolic Pressure ◽  
Coarctation Of The Aorta ◽  
Safety And Efficacy ◽  
Aortic Arch Hypoplasia

Abstract Background Despite a successful repair procedure for coarctation of the aorta (CoA), up to two-thirds of patients remain hypertensive. CoA is often seen in combination with abnormal aortic arch anatomy and morphology. This might be a substrate for persistent hypertension. Therefore, we performed endovascular aortic arch stent placement in patients with CoA and concomitant aortic arch hypoplasia or gothic arch morphology. The goal of this retrospective analysis was to investigate the safety and efficacy of aortic arch stenting. Methods A retrospective analysis was performed in patients who underwent stenting of the aortic arch at the University Medical Center Utrecht. Measurements collected included office blood pressure, use of antihypertensive medication, invasive peak-to-peak systolic pressure over the arch, and aortic diameters on three-dimensional angiography. Data on follow-up were obtained at the date of most recent outpatient visit. Results Twelve patients underwent stenting of the aortic arch. Mean follow-up duration was 14 ± 11 months. Mean peak-to-peak gradient across the arch decreased from 39 ± 13 mm Hg to 7 ± 8 mm Hg directly after stenting (p < 0.001). There were no major procedural complications. Mean systolic blood pressure decreased from 145 ± 16 mm Hg at baseline to 128 ± 9 mm Hg at latest follow-up (p = 0.014). Conclusion This retrospective study shows that stenting of the aortic arch is successful when carried out in a state-of-the-art manner. A direct optimal angiographic and haemodynamic result was shown. No major complications occurred during or after the procedure. At short- to medium-term follow-up a decrease in mean systolic blood pressure was observed.

Echocardiography of coarctation of the aorta, aortic arch hypoplasia, and arch interruption: strategies for evaluation of the aortic arch

2016 ◽  
Vol 26 (8) ◽  
pp. 1553-1562 ◽  
Author(s):  
Suma P. Goudar ◽  
Sanket S. Shah ◽  
Girish S. Shirali
Keyword(s):  
Aortic Arch ◽  
Coarctation Of The Aorta ◽  
The United States ◽  
Interrupted Aortic Arch ◽  
Hypoplastic Left Heart ◽  
Live Births ◽  
Additional Information ◽  
Non Invasive ◽  
Aortic Arch Hypoplasia

AimEchocardiography is the modality of choice for the diagnosis and serial follow-up of aortic arch pathology. In this article, we review the types of obstruction of the aortic arch, various classification schemes of coarctation of the aorta and interrupted aortic arch, methodology for optimal echocardiographic imaging of the aortic arch, and key echocardiographic measurements for accurate diagnosis of obstruction and hypoplasia of the aortic arch. Finally, we will discuss the limitations of echocardiography in optimal imaging of the aortic arch and the use of other non-invasive imaging modalities such as CT or MRI to provide additional information in these cases.BackgroundCoarctation of the aorta is the more common lesion of the two, with an estimated incidence of four in every 10,000 live births in the United States of America. Interrupted aortic arch is rarer, with an incidence of 19 per one million live births.1 There is a spectrum of pathology of obstruction of the aortic arch, ranging from coarctation of the aorta with and without hypoplasia of the arch to interrupted aortic arch. Both these lesions are frequently encountered in congenital cardiology practice, and will be discussed in the remainder of this article. Obstruction of the aortic arch in the setting of hypoplastic left heart structures or atresia of the aortic valve is beyond the scope of this review and will not be discussed further.

scholarly journals One-Stage Repair of Aortic Arch Hypoplasia Associated With Ventricular Septal Defect

2020 ◽  
pp. 52-56
Author(s):  
Y. Truba ◽  
R. Sekelyk ◽  
I. Dzyurii ◽  
L. Prokopovych ◽  
O. Golovenko ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Postoperative Period ◽  
Balloon Dilation ◽  
Early Postoperative Period ◽  
Long Term Results ◽  
One Stage ◽  
The Mean ◽  
Aortic Arch Hypoplasia

  Background. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by ground. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by hemodynamically significant narrowing of one or more segments of the aortic arch. Aortic arch hypoplasia combined ynamically significant narrowing of one or more segments of the aortic arch. Aortic arch hypop with ventricular septal defect (VSD) characterizes a special category of children who are in serious condition and need ptal defect (VSD) characterizes a special category immediate surgery. Despite the improvement in the results of surgical treatment of this abnormality in recent years, the gery. Despite the imp issue of choosing treatment tactics remains debatable. g The aim. To analyze immediate and long-term results of one-stage aortic arch hypoplasia repair and VSD repair in infants. Materials and methods. From 2011 to 2019, 55 infants underwent simultaneous aortic arch hypoplasia repair in ypoplasia rep conjunction with VSD repair at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and junction with VSD repair at the National Amosov Institute of Cardiovascular Surgery Ukrainian Children’s Cardiac Center. There were 30 (55%) male patients and 25 (45%) female patients. The mean age of (55%) male patients and 25 (45%) female patients. The mean ag the patients was 1.3 ± 1.2 months (from 0.1 to 9.1 months), the average body weight was 3.9 ± 1.3 kg (from 2.4 to 8.7 patients was 1.3 ± 1.2 months (from 0.1 to 9.1 months), the average body weight was 3.9 ± 1.3 kg ( kg). The mean body surface area was 0.27 ± 0.1 m2. Antegrade selective cerebral perfusion was performed in 23 (42%) g). The mean body patients during the aortic arch reconstruction. g Results.The hospital mortality rate was 1.8% (n = 1). The average duration of artificial circulation was 108.5 ± 38.6 minpital mortality rate was 1.8% (n = 1). The averag utes (from 55 to 204 minutes), aortic clamping time was 56.9 ± 36.4 minutes (from 21 to 126 minutes), the time of selec(from 55 to 204 minutes), aortic clamping time was 56.9 ± 36.4 minutes (from 21 to 126 minutes) tive cerebral perfusion was 26.4 ± 11.5 minutes (14 to 49 minutes). In eight patients (14.5%) the sternum was spread perfusion was 26.4 ± 11.5 minutes (14 to 49 minutes). In eight patients (14.5%) the sternum was sp apart in the early postoperative period. Echocardiography before discharge revealed the average pressure gradient at the part in the early postoperative period. Echocardiograp site of plasticity of the aortic arch of 20.5 ± 14.9 mm Hg. plasticity of the aortic arch of 20.5 ± 14.9 mm Hg. The mean long-term follow-up was 2.6 ± 2.1 years (from two months to 8.1 years). There were no fatal cases in the reg-term follow-up was 2.6 ± 2.1 years (from two months to 8.1 years) mote period. In 5 (9.1%) patients aortic arch restenosis occurred in the postoperative period; it was successfully treated period. In 5 (9.1%) patients aortic arch restenosis occurred in the postoperative period; it was successfully endovascularly by balloon dilation in 3 patients, the other 2 of them underwent repeated aortic arch repair. Long-term y by balloon dilation in 3 patients, the other 2 of them underwent repeated aortic arch repair. Long follow-up of other patients showed good results with respect to the pressure gradient at the aortic arch. There were p of other patients showed good results with respect to the pressure g no hemodynamically significant gradient after VSD closure. There were no neurological complications in the long-term follow-up. p Conclusions. One-stage complete repair is an effective and safe treatment for infants which provides good immedige complete repair is an effective and safe treatment for infants which provides g ate and long-term results. This surgical strategy may be an acceptable alternative to two-stage surgical treatment of this g complex pathology.

scholarly journals Estimation of variants of the pancreatic gland pathology in patients, suffering complicated forms of chronic pancreatitis in late postoperative period

2019 ◽  
Vol 86 (7) ◽  
pp. 18-22
Author(s):  
V. M. Ratchyk ◽  
D. V. Orlovsky ◽  
A. V. Tuzko ◽  
O. P. Petishko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Surgical Interventions ◽  
Group I ◽  
Group Ii ◽  
Surgical Tactics ◽  
Pancreatic Pathology ◽  
Late Postoperative Period ◽  
Pancreatic Gland

Objective. Estimation of variants of the pancreatic gland pathology and rate of the unfavorable results occurrence in late postoperative period in patients, suffering  complicated forms of chronic pancreatitis, depending on the procedures of surgical treatment. Materials and methods. Results of surgical treatment of complicated forms of chronic pancreatitis in department of the gut surgery in 2007 - 2017 yrs were studied in 107 patients, who were divided into two groups: the Group I – 67 (62.7%) patients, in whom pancreato- and virsungodigestive operations were performed, and the Group II – 40 (37.4%) patients, in whom duodenum—preserving resection-drainage surgical interventions were done. Results. Unfavorable variants of pancreatic pathology were observed significantly more frequently in patients of the Group I – in 34/67 (50.7%) in comparison with patients of the Group II – in 6/40 (15.0%) (χ2=9.49, p=0.002). Conclusion. Analysis of rate of the unfavorable results occurrence in late postoperative period, depending on surgical tactics appled, have shown a trustworthy advantage of the resection-drainage operations.

Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

2021 ◽  
pp. 105566562110251
Author(s):  
Vijay Kumar ◽  
Vidya Rattan ◽  
Sachin Rai ◽  
Satinder Pal Singh ◽  
Jai Kumar Mahajan
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Volumetric Analysis ◽  
Group I ◽  
Alveolar Bone Grafting ◽  
Group Ii ◽  
Demineralized Bone

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

scholarly journals Platelet rich plasma versus extracorporeal shock wave therapy in patients with non-calcific supraspinatous tears

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Samah M. Alian ◽  
Rabab S. Zaghlol ◽  
Sahar S. Khalil
Keyword(s):  
Shock Wave ◽  
Outcome Measures ◽  
Platelet Rich Plasma ◽  
Extracorporeal Shock Wave Therapy ◽  
Shock Wave Therapy ◽  
Tendon Tear ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Group Ii

Abstract Background To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear. Results Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed. Conclusion Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.

RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

2021 ◽  
pp. 51-54
Author(s):  
Md. Shafiqur Rahman ◽  
Sanjeeb Bhakta Bista ◽  
Md. Sayedul Islam ◽  
A. S. M. Shafiul Azam ◽  
Md. Shamim Hossain ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Recurrence Rate ◽  
Transurethral Resection ◽  
Tumor Recurrence ◽  
Controlled Trial ◽  
Intravesical Therapy ◽  
Newly Diagnosed ◽  
Group I ◽  
Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

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